Stringent fluid management might help to prevent postoperative ileus after loop ileostomy closure

Abstract

PurposeThe present study aimed to analyze the impact of perioperative fluid management on postoperative ileus (POI) after loop ileostomy closure.MethodsConsecutive loop ileostomy closures over a 6-year period (May 2011-May 2017) were included. Main outcomes were POI, defined as time to first stool beyond POD 3, and postoperative complications of any grade. Critical fluid management-related thresholds including postoperative weight gain were identified through receiver operator characteristics (ROC) analysis and tested in a multivariable analysis.ResultsOf 238 included patients, 33 (14%) presented with POI; overall complications occurred in 91 patients (38%). 1.7L IV fluids at postoperative day (POD) 0 was determined a critical threshold for POI (area under ROC curve (AUROC), 0.64), yielding a negative predictive value (NPV) of 93%. Further, a critical cutoff for a postoperative weight gain of 1.2kg at POD 2 was identified (AUROC, 0.65; NPV, 95%). Multivariable analysis confirmed POD 0 fluids of >1.7L (OR, 4.7; 95% CI, 1.4-15.3; p=0.01) and POD 2 weight gain of >1.2kg (OR, 3.1; 95% CI, 1-9.4; p=0.046) as independent predictors for POI.ConclusionsPerioperative fluid administration of >1.7L and POD 2 weight gain of >1.2kg represent critical thresholds for POI after loop ileostomy closure.